Towards a healthy urban living environment for all in Utrecht: a sytems approach (phase 2, IGLO)

Utrecht, the fourth largest city of the Netherlands, faces important challenges. Similar to other Dutch cities, large health inequalities exist between neighbourhoods. Further, its population will increase substantially in the next decades (from 350.000 now to 400.000 in 2027 and to 425.000 in 2040), and this increase will mainly be accommodated by building extra housing in the neighbourhoods with the lowest average life expectancies. Utrecht residents are concerned how the increased population density will impact on the liveability and social cohesion of their living environment. The main policy ambition of the city of Utrecht is to create a healthy urban living environment for all residents in the city. Indeed, the planned changes to the urban living environment may pose threats, but also offer opportunities to improve health and health behaviour of city residents. But how to achieve a positive impact on health, and what are the (foreseen and unforeseen) effects of spatial interventions? Evidence on the health and social impacts of interventions in residential neighbourhoods, specifically for those in the most deprived neighbourhoods, is limited, to some extent due to the complexity of evaluating such interventions. Firstly, the health impact of interventions is a complex interaction between residents and their environment, which requires a “systems perspective”. Secondly, data should be available at very local levels (as inequalities often manifest themselves within neighbourhoods) and should exist of a combination of high-resolution objective data and residents’ perceptions of their neighbourhood. Thirdly, reaching residents of the most deprived neighbourhoods is challenging; we argue that this is mainly due to the fact that inappropriate channels and methods are used. Insight is needed in new methods are needed. Fourthly, evaluation methods need to be applied that guarantee the continuous involvement of science, policy, professionals and residents in all stages of intervention development and evaluation. Building upon a research agenda developed in the first phase of this project, this project aims: (1) To advance methods to evaluate the health impact of complex, neighbourhood-based interventions in deprived neighbourhoods, including: a) the application of a systems thinking approach, b) the integration of high-resolution objective and residents-supplied subjective data, c) the development of new approaches to also involve “hard-to-reach” vulnerable groups in all stages of intervention development and evaluation; and (2) To evaluate the impacts of (a combination of) carefully selected interventions planned to take place in a deprived neighbourhood in Utrecht in the upcoming two years; and (3) To translate both aims into a policy and practice-relevant, transferable “blue print” for the selection and evaluation of area-based interventions (“working principles”), aimed at improving the health of residents with the largest health problems, to be made available for use in other cities, in and outside the Netherlands. To achieve these purposes, we identified four interventions that will take place in the next years within the neighbourhood of Overvecht (a post-war deprived neighbourhood in Utrecht), and which will be used as case studies.: a) the demolition of high rise social rented dwellings and the new building of a mix of dwellings; b) an improvement of the accessibility and use of nearby green areas (Gagelbos and Noorderpark); c) a social renovation intervention, aimed at the improvement of personal and housing conditions simultaneously; and d) the implementation of a “green walking route” aimed at improving physical activity and social cohesion. The project consists of five work packages, which focus on building systems models of these interventions (WP1), integrating the objective and subjective measurement of the living environment (WP2), improving the reach of vulnerable groups residing in Overvecht (WP3), application of insights gained in WP1-3 to evaluate the four case studies (WP4)and connecting science to practical implementation (WP5). The resulting blueprint will consider effective and innovative scientific evaluation methods developed during this project, building blocks of the living environment that will benefit everyone’s health and in particular the health of vulnerable inhabitants, as well as effective and innovative ways to involve the local stakeholders, such as the makers, professionals and inhabitants during the entire process. This project is led by a multidisciplinary team of representatives of city and provincial health policy experts, urban architects, housing corporations, the national forest service, who collaborate with scientists in the field of social geography, public health, environmental epidemiology, and sociology.